4.1 Study design
A qualitative descriptive study with a phenomenological approach was performed to define migrants’ women’s views on health care usage experiences and barriers or difficulties in
receiving culturally competent care. Qualitative research is a structured technique of explaining an individual’s experiences and inner emotions (Abedsaeidi and Amiraliakbari, 2015). The
phenomenological research method is mostly used in qualitative research where researchers try to understand the individual’s experiences in certain situations (Lester, 1999). It could be stated that qualitative research produces an exhaustive and profound outline of a phenomenon through data collection and introduce a rich report using an adaptable technique for research.
(Naderifar et al.,2017).
4.2 Participants and study setting
The participants involved in this study were immigrant women who live in different cities of Finland and were selected through purposive sampling. A total of 13 women have voluntarily participated. The inclusion criteria were migrant women age 18 and above, duration of residency in Finland was 5 years or less, born and raised in Asia particularly from Middle Eastern and South-eastern Asian countries, Legal immigrant, and to be fluent in English or Persian language.
(researcher’s mother tongue). The exclusion criteria were the second generation of immigrant women and undocumented migrant women as well as immigrant women with a residency of more than five years in Finland.
4.3 Description of data
Participants responded to join in the semi-structured in-depth interviews about cultural barriers, their challenges, and their experiences when accessing services. The open-ended questions were used. Probing techniques were used to provoke more information from participants by
confirming the slight pieces of information received during the interview. The interview produces information from participants in their own words. It allowed the researcher to examine the opinions and inherent cultural values to collect additional information that is not possible by the limitations of a questionnaire. Besides, demographic information (Appendix B) was collected from participants containing different dominoes (age, place of birth, education, marital status, employment, housing, income, Finnish Residency duration, mother tongue, Finnish language skill, health history, frequency of health services usage and use of traditional healing methods).
4.4 Recruitment and data collection
The study participants were recruited by sending the study flyer via social media (i.e., Facebook) and E-mail in the cultural centers and Finnish language courses of different cities in Finland. The study flyer included the research title, selection criteria, data collection period, type and the place of interview, name, and contact of the researcher.
The interviews took place from 4th November 2020 until 28th January 2021. In the early stage when reaching the target participants was difficult and recruitment progress was slow, snowball sampling or chain-referral sampling was used to recruit required samples for the study.
Snowball sampling is a comfort sampling technique that is used when subjects with objective qualities are difficult to access. In this technique, the current study subjects provide referrals to subjects amongst their contacts. (Naderifar et al.,2017.) Sampling was continued until the researcher reached data saturation. Data saturation is the most commonly used approach for approximating sample sizes in qualitative research (Guest et al.,2020). Saturation is an
instrument employed for guaranteeing that sufficient and quality information is gathered to help the study (Walker, 2012).
The interview questions were pilot tested before the main interview. Afterward, some slight changes were made to the interview questions (Appendix C). Overall, 16 participants showed interest to participate in the study but later only 13 participants responded to email or phone calls. Each participant was contacted by phone to explain briefly about the study process and after obtaining verbal approval and agreement about the time and date of the interview, a detailed email was sent about the study procedures with attachments of the consent form (Appendix A), background questionnaire (Appendix B), participant information sheet (Appendix D) and privacy notice for scientific research (Appendix E).
All documents were written in English first and then translated into the Persian language too.
Interviews were done only after receiving a signed consent form and filled background
questionnaire through E-mail. All interviews were conducted through Zoom software except for 3 participants who requested a face-to-face interview. Of which, 10 interviews were in English, and 3 interviews were in the Persian language. All research documents were saved on the password-protected file at the interviewer's computer which in this case is the writer of this thesis. The duration of interviews on average was about 30 minutes and all were audio recorded.
Before the start of the interview ensured that participants read and understood the information that was sent to them and briefly explained to them the purpose of the study. Moreover,
participants were asked if they have any concern or query before starting the interview and remind them not to mention their names or any other identifier during the audio-recorded interview so their confidentiality would be maintained. The interview atmosphere was positive and comfortable, and participants were approachable. The rich data collected with an average of 11-pages (with line spacing of 1.5 cm) transcript of each interview. After finishing interviews, recorded audio files also were saved with code assigned to each participant file and password protected. summary of data generation and analysis shown in figure 4.
Fig. 4: The process of data generation and data analysis
4.5 Data analysis
In this study, thematic analysis with the deductive orientation was used. The six steps of the thematic analysis process included Familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining, and naming themes, and producing the report. In the deductive approach creating code and themes are based on existing knowledge or theory.
(Clarke et al. 2019.)
Demographic Questionnaires Interview Quetions
Pilot Interview
Digitally recorded interviews data
Transcribe using a Microsoft Word format
Thematic Analysis & Use of Atlas.ti software
Data produced by digitally recorded interviews were transcribed with a made-up name allocated for each participant. The participant read the written copy and approved correctness or altered the transcript. Data analysis started by listening and observing during the interviews and then reading the interviews several times. The recorded interviews transcribed verbatim using Microsoft Word. When applicant checking was completed, the software of ATLAS.ti 9 was used for data analysis and data management as well as principles of coding, constant comparison, and theoretical sampling.
The ATLAS.ti software is a case of CAQDA (Computer Assisted Qualitative Data Analysis), which has been utilized by experts and numerous researchers from the various knowledge base, for example, management, education, anthropology, along with health care specialists like nurses, physicians, and psychologists (Friese et al., 2018). ATLAS.ti could be used with various theoretical methodologies and different data analysis procedures. The utilization of Thematic Content Analysis (TCA) defined by Braun and Clake (2006), is one of these potential approaches, and it is an asset for analyzing data in qualitative research (Vaismoradi et al., 2013). The ATLAS.ti
software's role in qualitative data analysis is to store and manage all data gathered for the research project at one spot. This implies that the researcher will no longer experience issues with manual works of removing parts of the story, framing a collection of papers and banners, or creating spreadsheets and blueprints to organize qualitative data. ATLAS.ti offers structures to integrate all the vital data for getting sorted out one’s research and has components to empower data analysis to be done in the software itself, intervened by the analyst, who keeps on assuming the main function in the analysis process being the basic scholar. (Friese et al.,2018.)
Thematic Analysis is an adaptable data analysis plan that qualitative researchers use to produce themes from the information of the interview. This method is flexible since there is no particular research design related to thematic analysis. This data analysis plan is ideal for both beginner and professional qualitative researchers as the stages are not difficult to follow; however, thorough enough to produce significant findings out of data. (Vaismoradi et al., 2013.)
Thematic analysis, like content analysis, is a blanket term for qualitative data analysis (Friese et al., 2018). According to Braun and Clarke (2013), thematic content analysis is a method of recognizing, analyzing, and writing themes within data. It slightly categorizes and defines the data set in full detail. Nevertheless, often it goes beyond this and interprets several features of the research topic. Braun and Clarke (2013) recommend that thematic analysis should be a primary method for qualitative analysis as "thematizing meanings" is among the rare
widespread generic abilities over qualitative analysis and it tends to be practical across a scope of epistemological and hypothetical methodologies.
Fig.5: Six steps of thematic analysis, (Clarke et al., 2019)
4.6 Ethical consideration
Participants read and signed written informed consent (Appendix 1) before the study. Informed consent indicates the right of voluntary participation and different aspects of the research in plain language. Participants received an information sheet (Appendix 4) which included the nature of the study, the participants’ potential role, the identity of the researcher, the research objectives, and the way the results will be stored and used. In addition to clarifying that
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participants will not benefit directly from participating in this research, however, there is a potential indirect benefit of contributing to knowledge about cultural beliefs and values that impact immigrant women's use of health care services, their health conditions, and health results.
The personal data processed according to the European Union General Data Protection
Regulation (EU: n Act 679/2016) and current national regulation (Data protection in the EU, 2020).
Detailed information on data protection management specific for this study was provided to a participant in advance as “Privacy Notice for Scientific Research” (See Appendix E). To keep personal information, secure data storage methods and elimination of identifier components were used. Information was accessible only to the researcher in the password-protected files and interview materials will be destroyed in 2024. Participants have withdrawal right from the study anytime they wish. Ethical concerns such as anonymity and confidentiality were applied throughout the research process.